OCT-Guided vs Angiography-Guided Coronary Stent Implantation in Complex Lesions: An ILUMIEN IV Substudy
Authors' conclusion
In complex angiographic lesions, OCT-guided PCI led to a larger MSA and reduced the serious MACE, the composite of cardiac death, target-vessel MI, or stent thrombosis, compared with angiography-guided PCI at 2 years, but did not significantly improve TVF.
Study context
- Population
- Patients with complex angiographic lesions (long/multiple lesions with intended stent length ≥28 mm, bifurcation with intended 2-stent strategy, severe calcification, chronic total occlusion or in-stent restenosis)trial N = 2,487
- Participants
- 992 vs 981
- Comparison
- Optical coherence tomography (OCT)-guided vs angiography-guided postpercutaneous coronary intervention (PCI)
- OCT-guidedn = 992
- Angiography-guidedn = 981reference
- Primary endpoint
- Final minimal stent area (MSA); serious MACE (cardiac death, target-vessel MI or stent thrombosis); TVF (cardiac death, target-vessel MI or ischemia-driven target-vessel revascularization)
- Follow-up
- 2 years (MACE, TVF)
Methodological detailsmulticentre, subgroup analysis (complex angiographic lesions)
- Multicentre
- Subgroup analysis (complex angiographic lesions)
Primary result
As reported in the abstract
OCT-guided vs Angiography-guidedDifference, mm2 (95% CI)P value
Final MSA
0.30(0.14–0.47)
P < 0.001OCT-guided vs Angiography-guidedHazard ratio (95% CI)P value
Serious MACE, 2 years
0.63(0.40–0.99)
P = 0.04- Target-vessel failure (TVF) not significantly different between groups (7.3% vs 8.8%; HR 0.82; 95% CI 0.59-1.12)
- P = 0.20
Original publication
OCT-Guided vs Angiography-Guided Coronary Stent Implantation in Complex Lesions: An ILUMIEN IV Substudy. J Am Coll Cardiol. Published 15 May 2024. doi:10.
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